Synopsis
Teach effective nasal spray delivery, distinguish corticosteroid maintenance from short-term vasoconstrictors, and recognise and reverse decongestant-related worsening of obstruction.
- Check the active ingredient because a corticosteroid and a vasoconstrictor have different purposes, onset and duration limits.
- Corticosteroid sprays work through regular anti-inflammatory treatment and do not need to create an immediate unblocking sensation to be effective.
- Clear the nose gently, follow device-specific priming instructions and keep the head slightly forward during administration.
Key red flags
New visual disturbance during corticosteroid treatment requires assessment; sudden visual loss or significant eye pain needs urgent ophthalmic review.
Investigation priorities
Identify remediable delivery errors and duplicate ingredients before escalation.
Management branches
A nasal corticosteroid is being started or response has been disappointing.
- Check the device leaflet for shaking and priming, then gently clear the nose before administration.
- Hold the bottle upright with the head slightly forwards and place the nozzle just inside the nostril.
Key medicines
Nasonex 50 micrograms per spray for adult allergic rhinitisUse two actuations into each nostril once daily, providing 200 micrograms daily; reduce to one actuation per nostril daily when controlled. For this device, prime ten times before first use and reprime twice after fourteen days or more without use; shake before each administration.
Dymista azelastine and fluticasone propionate combination sprayFor adults and adolescents aged twelve or over, give one actuation into each nostril morning and evening during the relevant allergen exposure period. Shake gently for about five seconds; prime six times initially and reprime once after more than seven days without use.